ICD-10 Coding for Palliative Care

The transition to ICD-10 coding in 2015 will be crucial for palliative care units since a large portion of their reimbursement are diagnosis driven. Palliative care ensures early identification, proper assessment and the most appropriate treatment for patients facing problems associated with life-threatening illnesses. The Affordable Care Act (ACA) includes palliative care under essential health benefits so that it is covered by all insurance plans. This ensures increased access to palliative care and higher reimbursement for care providers. If providers want to avoid claim denials and loss of reimbursement post ICD-10 implementation, they should understand how to apply these codes and enhance their documentation to accommodate new codes. Let’s take a look into how medical coding will change for the most commonly used diagnoses in palliative care unit.

Leukemia

There are five types of ICD-9 codes used to indicate leukemia such as:

• 204.00: Acute lymphoid leukemia without mention of having achieved remission
• 204.01: Acute lymphoid leukemia in remission
• 204.02: Acute lymphoid leukemia in relapse
• 205.00: Acute myeloid leukemia without mention of having achieved remission
• 205.02: Acute myeloid leukemia in relapse

In ICD-10 coding, there are more number of codes to indicate the type of leukemia more specifically. The codes are as follows:

• C91.00: Acute lymphoblastic leukemia not having achieved remission
• C91.01: Acute lymphoblastic leukemia, in remission
• C91.02: Acute lymphoblastic leukemia, in relapse
• C92.00: Acute myeloblastic leukemia, not having achieved remission
• C92.40: Acute promyelocytic leukemia, not having achieved remission
• C92.50: Acute myelomonocytic leukemia, not having achieved remission
• C92.60: Acute myeloid leukemia with 11q23-abnormality not having achieved remission
• C92.A0: Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
• C92.02: Acute myeloblastic leukemia, in relapse
• C92.42: Acute promyelocytic leukemia, in relapse
• C92.52: Acute myelomonocytic leukemia, in relapse
• C92.62: Acute myeloid leukemia with 11q23-abnormality in relapse
• C92.A2: Acute myeloid leukemia with multilineage dysplasia, in relapse

Complications of Bone Marrow Transplant

There is only one code in ICD-9 to report complications of bone marrow transplant.

• 996.85: Complications of bone marrow transplant

There are five codes in the new system to indicate the type of complication.

• T86.00: Unspecified complication of bone marrow transplant
• T86.01: Bone marrow transplant rejection
• T86.02: Bone marrow transplant failure
• T86.03: Bone marrow transplant infection
• T86.09: Other complications of bone marrow transplant

Congenital Reduction Deformities of Brain

In the ICD-9 system, there is only one code to report this condition.

• 742.2: Congenital reduction deformities of brain

At the same time, there are four codes to specify the same condition in the new system.

• Q04.0: Congenital malformations of corpus callosum
• Q04.1: Arhinencephaly
• Q04.2: Holoprosencephaly
• Q04.3: Other reduction deformities of brain

Edwards’ Syndrome

ICD-9 has only one code to report Edwards’ syndrome, which is:

• 758.2: Edwards’ syndrome

However, four codes are there in the new coding system to indicate the same.

• Q91.0: Trisomy 18, nonmosaicism (meiotic nondisjunction)
• Q91.1: Trisomy 18, mosaicism (mitotic nondisjunction)
• Q91.2: Trisomy 18, translocation
• Q91.3: Trisomy 18, unspecified

Other Myopathies

ICD-9 uses one code to specify all other myopathies:

• 359.89: other myopathies

However, the new system uses three codes to specify other myopathies, which are:

• G71.3: Mitochondrial myopathy, not elsewhere classified
• G71.8: Other primary disorders of muscles
• G72.89: Other specified myopathies

Other Primary Cardiomyopathies

There is only ICD-9 code to specify all other primary cardiomyopathies

• 425.4: Other primary cardiomyopathies

There are four codes in the new coding system to indicate cardiomyopathies more specifically.

• I42.0: Dilated cardiomyopathy
• I42.5: Other restrictive cardiomyopathy
• I42.8: Other cardiomyopathies
• I42.9: Cardiomyopathy, unspecified

Other Specified Congenital Anomalies

ICD-9 system uses a single code to represent all other specified congenital anomalies.

• 759.89: Other specified congenital anomalies

The new system has codes to report more specified congenital anomalies, which include:

• E78.71: Barth syndrome
• E78.72: Smith-Lemli-Opitz syndrome
• Q87.2: Congenital malformation syndromes predominantly involving limbs
• Q87.3: Congenital malformation syndromes involving early overgrowth
• Q87.5: Other congenital malformation syndromes with other skeletal changes
• Q87.81: Alport syndrome
• Q87.89: Other specified congenital malformation syndromes, not elsewhere classified
• Q89.8: Other specified congenital malformations

There are equal numbers of codes in both ICD-9 and ICD-10 for reporting hypoplastic left heart syndrome and malignant neoplasm at palliative care unit.

ICD-9

• 746.7: Hypoplastic left heart syndrome
• 170.6: Malignant neoplasm of pelvic bones, sacrum, and coccyx
• 191.3: Malignant neoplasm of parietal lobe
• 191.6: Malignant neoplasm of cerebellum
• 191.7: Malignant neoplasm of brain stem
• 191.9: Malignant neoplasm of brain, unspecified

ICD-10

• Q23.4: Hypoplastic left heart syndrome
• C41.4: Malignant neoplasm of pelvic bones, sacrum and coccyx
• C71.3: Malignant neoplasm of parietal lobe
• C71.6: Malignant neoplasm of cerebellum
• C71.7: Malignant neoplasm of brain stem
• C71.9: Malignant neoplasm of brain, unspecified

ICD-10 documentation must be specific and more comprehensive to accommodate all these codes. For example, the ICD-10 documentation for leukemia must specify the actual type (Acute lymphoblastic, Acute Myeloid, Acute Myelomonocytic, Acute promyelocytic, Acute Myeloblastic) and identify the disease status as being ‘In remmission’, ‘Not having achieved remission’ and ‘In relapse.’